Thoracoscopic repair of chronic post-traumatic diaphragmatic hernia shows promising outcomes with significant advantages over open surgery for defect sizes up to 100 mm.

• In a study of 21 patients, thoracoscopic repair resulted in lower median blood loss (10 ml vs. 200 ml), shorter chest tube duration (1 vs. 4 days), and reduced hospital stay (5 vs. 10 days).
• No recurrences or major complications occurred during follow-up, bolstering the feasibility of the minimally invasive approach for selected patients.

Surgeons should consider thoracoscopic repair for appropriately sized chronic defects, as adverse factors often favor an open approach.